Spine Surgeons conducting surgery for Myofascial pain


 Myofascial pain syndrome is a disorder in which pressure on sensitive points in the muscles causes pain in seemingly unrelated body parts. The syndrome often happens after repeated injury or muscle overuse.

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3 percent of individuals with progressive curvature may eventually experience severe problems that can include scoliosis and back pain, spinal problems, and nerve compression causing numbness, weakness, and leg pain.

Myofascial Pain

Myofascial PainA patient with myofascial pain is a common chronic pain condition that affects your muscles and fascia. “Myo” refers to muscle, and “fascial” refers to the fascia. Specifically, the fascia is a thin layer of connective tissue that connects, encloses, and separates muscles from adjacent internal organs. If you have myofascial pain, you may feel pressure and/or tenderness on specific points in your muscles. Furthermore, trigger points are areas of pain or tenderness that occur in specific locations. Generally, they are easy to identify because they feel like small bumps or knots in your muscle. A trigger point, also known as a “knot,” is a group of muscle fibers that remain contracted for extended periods of time. Blood flow through those areas stops, resulting in a buildup of waste materials and a decrease in oxygen levels.

The combination of these events leads to pain and discomfort. When pressure is applied to a trigger point in some patients, it may cause pain in other areas of the body; this is known as referred pain. Myofascial pain syndrome can affect the lower and upper back, as well as the neck, shoulders, and chest. While most people experience some form of muscle tension throughout their lives, Myofascial pain disorder is differentiated by its persistence and progressively debilitating nature. Finally, Myofascial pain does not go away on its own and requires treatment to relieve the pain.

How Common Myofascial Pain

Myofascial pain occurs in approximately 85% of people at some point in their lives. However, because this condition can sometimes be hidden in other types of diagnoses, such as headache, neck and shoulder pain, pelvic pain, limb pain, or nerve pain syndrome, myofascial pain is frequently underdiagnosed, misdiagnosed, or overlooked, and thus, the aforementioned percentage may be incorrect.

Questions and Answers

What is Myofascial Pain?

Myofascial pain refers to the discomfort or pain that arises from myofascial trigger points, which constitute hyperirritable spots in the muscles or fascia (connective tissue). These trigger points identify as small nodules or bands within the affected muscle. Myofascial pain can exist in one specific area or be in other areas as well, and doctors recognize it by a patient experiencing muscle stiffness, tenderness, and restricted range of motion.

What causes Myofascial Pain?

There are several factors that cause Myofascial Pain, including muscle overuse or repetitive movements, poor posture, muscle imbalances, physical trauma, stress, or underlying medical conditions. Trigger points can develop due to muscle fibers becoming contracted and shortened, leading to the formation of tight knots or bands within the affected muscles. These trigger points can cause local pain and may also refer pain to other areas of the body.

How is Myofascial Pain Diagnosed and Treated?

Diagnosis and treatment of myofascial pain typically involve the following approaches:

  • Clinical assessment: The healthcare provider will perform a thorough evaluation, which includes taking a detailed medical history, conducting a physical examination, and assessing pain patterns and trigger point presence.
  • Trigger point injections: In some cases, doctors will use injections at trigger points to alleviate myofascial pain. This involves injecting a local anesthetic or other medication directly into the trigger points to release muscle tension and reduce pain.
  • Manual therapy: Techniques such as massage, myofascial release, and stretching exercises can help relieve muscle tension, reduce trigger point activity, and improve muscle flexibility and function.
  • Physical therapy: Doctors will often recommend Physical therapy to address underlying muscle imbalances, correct postural issues, and improve overall muscle strength and stability.
  • Pain management: Nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, or other pain medications may be prescribed to manage pain and inflammation associated with myofascial pain.
  • Stress reduction techniques: Doctors will recommend stress management strategies such as relaxation exercises, mindfulness, and stress-reducing activities to manage myofascial pain, as stress can contribute to muscle tension and trigger point development.
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Symptoms of Myofascial Pain

Myofascial pain symptoms usually include muscle pain with a specific trigger point. Symptoms of Myofascial pain commonly include:

  • Severe pain in specific muscle groups.
  • Excessive pain when the affected muscle is stretched or strained.
  • Muscle pain that worsens or does not improve over time.
  • The presence of painful knots in muscles that cause intense localized or referred pain when pressed.
  • Weak, stiff, inflexible, or limited range of motion muscles
  • Disturbances in mood or sleep.

Myofascial Pain Causes and Risk Factors

A stimulus, such as muscle tightness, sets off trigger points in your muscles, resulting in myofascial pain syndrome. Factors that may increase your chances of developing muscle trigger points include:

  • Muscle injury. Trigger points can form as a result of an acute muscle injury or continuous muscle stress. A trigger point may form within or near a strained muscle, for example. Repetitive motions and poor posture may also put you at risk.
  • Stress and anxiety.  People who are frequently stressed and anxious are more likely to develop trigger points in their muscles. According to one theory, these people are more likely to clench their muscles, a type of repeated strain that leaves muscles unprotected to trigger points.

Myofascial pain is typically caused by a muscle injury caused by excessive strain on a specific muscle or muscle group, tendon, or ligament. Other potential reasons for myofascial pain contain:

  • An intervertebral disc injury.
  • Feeling tired in general.
  • Repetitive movements.
  • Certain medical conditions, such as stomach aches or heart attacks.
  • Absence of activity.

Secondary causes of myofascial pain include the following.

  • Poor posture.
  • Hormonal shifts.
  • Deficits in nutrition.


A specific test cannot form the basis for diagnosing Myofascial pain syndrome. A doctor will examine a patient with the aim of ruling out other conditions that mimic the symptoms, such as fibromyalgia or cubital tunnel syndrome. An examination may consist of: Inquiries about the pain, such as:

  • Potential risk factors include repetitive movements and recent injuries.
  • Where the pain occurs.
  • How frequently the person feels pain.
  • when they feel the pain.

Physical exam

A doctor will use gentle pressure to detect tight bands of muscle that may cause twitches or pain.

Visual exam

The doctor will look for postural abnormalities such as shoulder hunching or a forward head position that is misaligned with the spine.

Imaging and diagnostic tests

X-rays and ultrasound scans can rule out other conditions.

Treatments Options

Myofascial pain syndrome requires a diverse treatment strategy. Many people use medications in accordance with other therapies to relieve muscle stiffness and pain. Although there is no conclusive evidence to support one therapy over another, exercise is considered an important component of any treatment program. Consult your physician about your treatment possibilities and preferences. To find pain relief, you may need to try more than one method.


Several medications can help to alleviate the symptoms of Myofascial pain syndrome including:

NSAIDs (nonsteroidal anti-inflammatory drugs)

The use of over-the-counter drugs such as ibuprofen (Advil) and acetaminophen (Tylenol) can reduce pain and swelling.


Pain relievers like lidocaine or diclofenac patches, tramadol, COX-2 inhibitors, and tropisetron (not available in the US) will also reduce pain and swelling.

Muscle relaxants

Benzodiazepines and tizanidine (Zanaflex), can help with muscle spasms.


Gabapentin (Neurontin) and pregabalin (Lyrica) can help with pain and muscle spasms.

Tricyclic antidepressants

These are used to treat chronic pain, fibromyalgia, and nerve pain, all of which constitute symptoms of Myofascial pain syndrome.

Botulinum type A injections

Botulinum type A is a powerful neurotoxin that prevents muscle contractions and may have pain-relieving properties.

Dry needling

Dry needling is one of the most effective methods for deactivating myofascial trigger points. A needle gets inserted directly into your trigger point, moved around, and poked in and out by your doctor. Although painful, it is one of the most effective ways to deactivate a trigger point and reduce pain. Some medical professionals employ acupuncture needles, which are thinner and less uncomfortable than hypodermic ones. There are several significant differences between dry needling and acupuncture.

Trigger point injections

Trigger point injections are similar to dry needling in that a solution is injected into the tissue. Typically, doctors will inject saline or a local anesthetic such as lidocaine. The effects are comparable to dry needling, but the procedure creates less discomfort. Steroid trigger point injections can also be a treatment to relieve pain.

Ultrasound therapy

Ultrasound machines send sound waves into tissue via a sound-conducting gel applied to the skin. Sound waves have the ability to heat and relax muscles, improve blood flow, and remove scar tissue. The pain-relieving effects could be minor. However, if performed prior to stretching, this treatment may reduce stiffness and increase mobility. Ultrasound therapy has been shown to be effective for rheumatoid arthritis pain, so it is worth discussing with your doctor.

Massage therapy

Massage treatments of various types can relax myofascial trigger points. These are some examples:

  • rhythmic passive release
  • rhythmic active release
  • Shiatsu massage (acupressure).
  • release of trigger point pressure.

Hence, massage therapy improves blood circulation and warms muscles. This can help with stiffness and pain relief. The massage therapist may apply pressure to your trigger points with their thumb, causing pain and then releasing muscle tension.

Spray and stretch

Many people suffering from Myofascial pain syndrome benefit from stretching. Before directing someone through stretches, some physical therapists apply a cold, numbing spray to the muscle area. You can also try some gentle exercises and stretches at home to relieve pain.

Home Remedies

You can take numerous steps in your household to decrease pain and improve your quality of life.

  • Improve your posture at work by choosing a better chair.
  • Adjust the height of your computer so that it is in line with your natural eye line.
  • You may feel more pain if you are stressed and tense. Find ways to relax and enjoy. Meditation, journaling, and talking with friends can all be beneficial.
  • Utilize a good diet rich in fruits and vegetables. Change your sleeping position or try a new mattress. Sleep enough so that you can awaken feeling rested. Take care of your body so you can devote your energy to dealing with your pain.
  • Stretch your body with yoga, Pilates, or another stretching technique. These Pilates exercises for fibromyalgia patients may also help your MPS symptoms.
  • When doing the heavy lifting, use a back brace.
  • Use a vibrating or personal massager.
  • Start an exercise program and move your muscles every day.
  • Consult with a mental health professional to reduce your stress level.
  • Apply an ice pack to any muscle injury right away.
  • To treat muscle inflammation, apply moist heat.
  • Take a warm bath.
  • Utilize a traction device.
  • Use mindfulness to manage pain.

Complications and Outlook

Myofascial pain syndrome can have an impact on your quality of life. You may be unable to engage in physical activities that you previously enjoyed. This could result in depression and social isolation. MPS can also have an impact on your mobility. Seeking treatment as soon as symptoms appear, joining a support group, and talking with friends and family can all help. MPS can be a difficult condition to live with. Comprehensive treatment will be essential in managing the pain. There is no single treatment that works best for everyone, so don’t be discouraged if the first treatment does not completely work. However, MPS pain can be successfully managed by the doctors at the Southwest Scoliosis and Spine Institute, with offices in DallasPlano, and Frisco, Texas by implementing treatments that work along with healthy lifestyle choices.


American Society of Anesthesiologists: Myofascial Pain



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